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By the following day, Wednesday, my don’t-care view of a. fib. had been replaced by a cringing wariness. I walked around carefully, as if my heart were made of glass, and I was carrying it on a velvet cushion of my breathing. I felt whipped. The procedure had jangled my entire system, as I knew it would—any operation, no matter how minor, takes anywhere from a week to a month to recover from, and don’t let anyone tell you otherwise—but this particular event had left me shuffling around like an old man in bedroom slippers. Life in the household went on around me. I once knew a bunch of ageing rockers who decided to name their band Old And In The Way, and I knew just what that phrase meant.

Even walking up and down stairs took a certain deliberateness, as if I were carrying a loaded tea-tray in my chest—but once again it wasn’t when I was active that things went wrong. It was when I tried to be inactive.

The event started out around 10 p.m. like a no-account threat, a slight uncertainty. My heart stuttered, but then beat fine for half-a-dozen beats or so, then stuttered again, then picked up its rhythm once more. I walked into the bathroom, which seemed to throw things off balance a little more, and took a bath, which seemed to settle everything down completely. It wasn’t until I tried to lie down in bed that everything got out of control. For the first time I felt the familiar invasion, the abrupt manic whacking in my chest. I sat back in an armchair and laid my right palm over my heart, as if this would somehow offer it sympathy and encouragement, and slowed my breathing to cathedral calm. And for a while that worked.

Over the next twenty minutes, though, the tension and the stakes rose. By 11:30 I felt as though I were in a medieval morality play in which the stage represents Everyman’s soul, which in turn is the battlefield on which the forces of chaos strike at the forces of order, trying to overthrow them and establish violence and despair.

My heart beat normally for four or five beats, sometimes as many as thirty, but then a kind of invasion took place: my arms felt as if they needed to flail or twitch, and this current converged on my heart, which abruptly went into spasm, beating hard and fast, feeling less as if it were beating and more as if it were being beaten. These were heartbeats that had nothing to do with circulation of blood: they were a kind of war drum, or a great gate being battered. My chest and throat constricted, and that sense of squeeze rose into my ears, which grew hot, and my head. I felt dizzy, and head a soundless buzzing. And yet this most extreme symptom was the sign that everything was passing, because the energy, like a tiny, vicious whirlwind, seemed to rise out of the top of my head, leaving silence and calm behind, and when I recovered and looked around—well, inside—the attack was over, and my heart was like a mild sea breaking at the foot of the castle walls.

During the attacks, I felt so besieged I couldn’t speak, and had to give Barbara instructions in sign language. As soon as it had passed, though, I had the absurd sense that I was talking as casually as a Noel Coward character, sitting in a drawing-room armchair, wearing a dressing-gown and mildly waving a cigarette-holder to make his points.

After about an hour and a half, I quit trying to fight this battle on my own. I got Barbara to drive me to the hospital again.

It was like Homecoming Weekend. I was delighted to see the action-figure silhouette of Dr. Peter Weimersheimer, who greeted me like the artistic director of a summer-stock theater company greeting one of his New York actors, back for another season on the rural boards.

Once again I was on the bed, wired to the monitor, IV in my arm. Yet Weimersheimer seemed curiously reluctant to describe what was going on as atrial fibrillation. Like me, he felt that this curious two-phase see-saw that was going on was different from the out-and-out madness of two nights previously. “There’s something called atrial flutter,” he said, but on the discharge sheet he would ultimately write simply “Palpitations.”

As usual, I was trying to deal with the weirdness and anxiety of the situation by studying it, and myself. The most peculiar aspect of the night’s upheaval was that it reminded me more than anything else of Restless Leg Syndrome.

RLS, as it is abbreviated, is a mysterious neuromuscular disorder. Nobody knows what causes it, though in my case there may be a genetic component, as my mother had RLS, too. It’s one of the strangest and most infuriating of sensations: a kind of energy or impulse appears in (usually) one leg, making you feel as if you need to twitch or kick it. (I heard a Tourette’s Syndrome sufferer describe exactly the same build-up that, no matter how hard you try to relax or to fight it, forced him to burst out in a kind of verbal twitch.) It can go on for hours, and most frustratingly—and most like my a. fib. symptoms—it typically starts just when you’re trying to relax. I’ve had it since I was 19, though often it has vanished for years at a time, and at its worst it would keep me up virtually all night until, utterly exhausted, I felt like crying in frustration.

Whatever this particular cardiac event was all about, it seemed to behave much like RLS—only instead of creeping into the nerves and muscles of my thighs or calves, it crept into my left shoulder and pectoral muscle. The first sign that my calm phase was about to end, in fact, was that my pec/shoulder area started to feel that build-up of electrical charge, which then seemed to dive down and sideways, sending my heart into its manic phase. It was as if I had Restless Heart Syndrome.

I twitched around in this fashion until around 1 a.m., and then began noticing something else that seemed odd. The phases seemed to be polarizing. The manic phase was, if anything, more manic—at its peak I felt hot and dizzy and on the verge of passing out—but the calm phase lasted longer and longer. In the end, it was as if the existential battle was won by the forces of order if only because the forces of chaos had retreated, perhaps to regroup and mount another attack another day, perhaps to go and try to win someone else’s soul.

I left sometime before 2 a.m. Weimersheimer gave me one metropopol, a beta-blocker that would slow my heart (though not do anything specifically about the arrhythmia) and another one to carry home and take in the morning. He also left phone messages for my internist and the cardiologist I had seen five years previously, Dr. John Fitzgerald, who would make time to see me later that same day.

They were clearly serious about this chaotic cardiac event, whatever it was. Time to ramp up the gear and find out what the heck was going on.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

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For the next five years, my heart behaved itself. I played soccer, climbed a couple of mountains, rode my bike, and all the time my heart beat faster or slower as need demanded. It didn’t particularly worry me that we never knew what had gone wrong that first time. It never occurred to me that I knew nothing at all about what makes a heart go faster or slower, or what makes it beat at all. Ironically, as an essayist I looked into my heart all the time, but only in the introspective sense. I even turned down an offer to develop my experiences and reflections on my cardiac adventure into a book. Sorry, I said. Nothing happening any more. And that’s pretty much how and where the story picks up again, just a few weeks ago.

Shock Treatment

It was a Monday night in late July, over the summer break. For once I had actually had something approximating to a vacation, a week on Nantucket, cycling every day, reading books, playing guitar. Felt as fit as I had done any time in the past five years.

Two weeks later, around midnight, unable to get to sleep and lying on the couch, the old barrel-of-monkeys feeling returned, swiftly, without warning. My heart was thumping hard and fast at the base of my throat, then stopping, then thumping hard and fast again.

It was a shock—in fact, it was exactly the kind of shock that happens when I’m on a long overnight flight, and relax enough to be drifting off to sleep, and then something terrifying happens: maybe the plane bumps slightly, maybe it’s my own anxiety creating the fall, but I feel as if I start falling, shoot out a hand and catch myself. Sometimes the feeling forces its way into a dream, and I start falling backwards off a tree branch and just manage to grab hold…. It almost doesn’t matter. It’s the aftermath that matters, that horrible sense that some kind of catastrophe was just averted, and now I’m awake and sweating, and my heart is hammering in my ears.

This time there was no plane, or maybe I myself was the plane I was falling out of; and this time the shock was so great that my heart was spastic. In those five years I’d forgotten how disturbing, how wrong it feels to lose one’s rhythm. I’d almost forgotten my heart was even there.

Once again I went through everything I’d tried the first time. Holding my breath in. Holding my breath out. Reading. Taking a bath. Nothing worked. If I lay down my heart felt ten times its normal size, bashing around my chest and up into my gullet. If I stood up I felt light-headed. Sometimes I’d get three or four normal beats in a row—a dozen would have felt like a miracle—but then a beat would get lost altogether, or ten double-time beats would charge in, and the illusion that things were settling down was trampled to death.

This went on all night. Midnight until around 7 a.m. By then there was no longer any way to deny it: I had to go to the emergency room. I tiptoed into the room where Barbara was sleeping, woke her and asked her to give me a ride. She would need the car during the morning—better she drop me off than I just drive myself, light-headed and all.

At 7:30 a.m. on a Tuesday morning, the place was almost empty, and I was admitted at once. Over to a bed, shirt off, gown on, electrodes sticking to the hair on my chest, the monitor beeping on and off all the time, either because my heart was going crazy or because the electrodes couldn’t get a good contact. Some shaving. As before, an IV and diltiazem to slow the racing pulse. A nurse, a tech, and a doctor with the ultra-fit buzz-cut build of an action figure but a confident and calming manner.

So the monitoring began. Barbara decided to stay.  My heart slowed, but beat as erratically as ever.

Another patient was admitted and shown to the bed next to mine. Either some extraordinary and eerie coincidences are guiding me or else there’s far more a. fib. around than I thought, because just like five years ago, the patient in the bed next to me also suffered from a.fib.

Just as was the case last time, it was a middle-aged man, blue-collar background, whose symptoms were considerably worse than mine. This time the guy had been suffering from several years, and was on both beta-blockers and blood-thinners. Even so, he’d come into the hospital because he’d had a series of attacks that had been going on for three days. Three days!

Hs presence also reminded me that there’s always someone else who is worse off than I am—and as if to underline that, I overheard someone at the nurse’s station call, “Can someone sit with the patient in bed 37? Suffering from suicidal ideation.”

This strange, half-tense, half-drowsy state persisted for two hours. The action-figure doctor,who in civilian life was called Peter Weimersheimer, started saying things like “Well, if there’s no change, we’ll just convert you.”

I recognized a euphemism when I heard one: this was the defibrillator, the paddles, the galvanic twitch of the body on the gurney. It wasn’t until he brought the subject up for the third time that he used the phrase “shock you,” and I appreciated his efforts to keep panic at bay.

By about 10 a.m. it was clear nothing was going to change in the ER, and nothing was to be gained by going home. “Let’s do it,” I said.

They were going to give me a quick-acting sedative through my IV, Weimersheimer said, and also some painkiller. I assumed the painkiller was so I wouldn’t feel too bruised and beaten up when it was all over, but he gave a different reason. Even though I wouldn’t know or feel a thing during the cardioversion, he told me, fumbling for his words a little as if all this New Age stuff still sounded a little strange to him, he felt as though patients with a little painkiller in them seem to react…um…less during the procedure, seemed to tolerate it better. Even in my dopey state, I realized that this was a hint: while it was true that everything about the cardioversion was routine and effective, he was saying, it was also violent and alarming, at least to those who were conscious and watching.

“You don’t have to stick around,” I told Barbara, suspecting that the whole episode might be as distressing for her as it was for me—but she insisted, and pulled out her iPhone.

“I’m going to film it,” she said.

This struck me as a potentially terrible idea, but my job right now was to let the world drift away. The nurse fiddled with my IV, and I began to feel distinctly mellow. I closed my eyes, then vaguely opened them, then closed them again.

“How are you feeling?”  the nurse asked.

“Very relaxed,” I slurred. Mentally, I rolled over and cocked an ear to my own chest. My heart was quiet. Quiet, as in pulsing regularly and gently, its voice faded back into the general background noises of my body. I was blurrily delighted. The sedative must have quietened it back into normality.

“Hey, it worked!” I said cheerily, if still a little fuzzily.

“Yes, it did,” Weimersheimer said, and seemed to withdraw along with his retinue until only the nurse and Barbara were left.

“How are you feeling?” Barbara asked again–and something about the way she asked made me realize that something had happened to make her ask that question in that tone. It took me a while, but I finally got it: the cardioversion had taken place without my having the slightest knowledge of it, all over in less than five minutes, and the only way I could tell was that the right side of my upper chest, between my collar-bone and my nipple, felt as though someone had punched it.

I got dressed, feeling a little odd, was given a summing-up sheet that said my diagnosis was atrial fibrillation, and we went home.

By now it was almost noon. I lay around the house, feeling benign but oddly incurious. Now that it was over, this attack, this procedure I’d dreaded, what had I learned? When anything as strange and new and threatening as this is over, what you’ve mostly learned is that it’s over. I didn’t want to follow up with the cardiologist or my family doctor. I didn’t want to watch the video Barbara shot with her phone. What I clung to instead was that it was over and had, in fact, been fixed in five minutes using a procedure that I didn’t even know had happened. How easy! How swift! For most of Tuesday the cardioversion had the qualities of a magic spell: the demon had been killed, and could be killed at will whenever necessary. All I felt, at first, was the wonderfully mellow after-effects of the morphine and the conclusion that I didn’t have to think about atrial fibrillation any more.

That tranquility lasted until late afternoon. By then, odd signs were surfacing. My right pectoral area felt bruised, as if it had been punched. I’d forgotten that morphine makes you constipated. Some of the skin cells on my chest had been ripped off along with the defibrillator pad, and that area smarted, then stung, then felt so raw I had to ice it in order to get to sleep. And by then my back and knees were aching something fierce. It was as if all my innards had been violently shaken—as, of course, they had. The science had lost its magic: I wasn’t so keen on going through all this again, after all.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.